Description
Community Health Centers (CHCs) serve an important role in the American healthcare system by providing low or no cost services to patients that face financial, cultural and geographical barriers to care. However, CHCs are often reliant on specific federal Health Center Grants to maintain operations. These discretionary funds have repeatedly been threatened by political shifts, budget cuts and government shutdowns. This paper explores whether the independent variables of Clinic Designation as a Federally Qualified Health Center (FQHC) or Look-Alike Clinic and Health Center Grant expenditures, are associated with the dependent variables of cost per patient, and the extent to which a range of health services were offered (including dental services, mental health, enabling services), and rates of depression screening, hypertension control, and diabetes control. Using Berwick’s Triple Aim as a conceptual model, all dependent variables were categorized as measures of Cost, Access, or Population Health. Aggregated CHC data reported through the Uniform Data System (UDS) in 2016 were used to complete independent t-tests and Fisher’s Exact Test to determine if FQHCs (n = 1,366), which receive federal grants, perform differently on Triple Aim measures than their counterpart Look-Alike Clinics (n = 59), which do not receive federal grants. FQHCs were found to perform better than Look-Alike Clinics in providing Dental Services (FQHC M=87.8%, Look-Alike M=29.4%), Mental Health Services (FQHC M=90.6%, Look-Alike M=55.9%), Enabling Service (FQHC M=75.5%, Look-Alike M=41.2%), and Depression Screenings (FQHC M=60.7%, Look-Alike M=42.8%). Look-Alike Clinics were found to have lower Cost Per Patients than FQHCs (Look-Alike M=$589.25, FQHC M=$836.37). Bivariate logistic regressions were performed on data from FQHCs to determine the extent to which Health Center Grant expenditures are associated with positive performance on measures of the Triple Aim. Higher Health Center Grant expenditures were found to be associated with increased likelihood that clinics offered Dental (Exp(β)=1.08, p=0.000), Mental Health (Exp(β)=1.03, p=0.000) and Enabling Services (Exp(β)=1.04, p=0.000). The results suggest that there is a relationship between receiving Health Center Grants and clinic success. Policy changes may be necessary to ensure the sustainability of the Health Center Program, CHCs and the vulnerable patients they serve.
